Training for Reduction of Neonatal Mortality - India

A 3-year randomized programme with 39 intervention villages and 47 control villages. Year 1 - home visit by health worker, Year 2 - management of sick neonates added, Year 3 - individual and group health education added. TBAs were considered the portals of entry to neonates. The programme functioned through a team that included the mother, grandmother, health educator, the TBAs, the village health workers and the supervisory team. Village health workers (20-40 years old with 5-10 of schooling) were trained in identifying criteria for babies at risk of death, prematurity, low birth weight (below 2000g) and sepsis. They were retrained every month to ensure that they retained their skills. Village health workers reports were verified by supervising physician and there was 90% agreement on data collection by physician and village health worker.

Health and nutrition, children, women.

This area has 95% home deliveries taking place in unhygienic conditions. Breastfeeding was generally not done in 1st three days, and prematurity and asphyxia were not recognized. 85% of babies had some form of morbidity. In 1995, at the start of the project, there were 40 deaths in 763 newborns: 52% deaths due to sepsis and 20% due to asphyxia. RESULTS: Before training 163 cases of neonatal sepsis and case fatality of 16.6%. After training VHW treated 71 cases and case fatality of 2.8%. Missed/refused treatment 33 cases with case fatality 21%. Hospital treated 7 cases with case fatality of 14%. 76% reduction in sepsis. 59.5% reduction in neonatal mortality due to sepsis. Cost per newborn $5. Per capita 12 cents. Neonatal mortality down by 62%, IMR down by 46% and cost per life saved $97.